Abstract

This thesis investigates the views of English social workers and child and adolescent mental health service (CAMHS) clinicians about how social workers use the Strengths and Difficulties Questionnaire (SDQ) with looked after children. Focus groups and semi structured interviews (conducted 2011 - 2013) examined social workers’ (n = 58, from nine local authorities) understandings of the mental health needs of looked after children and their use of the SDQ in assessing this, as well as how CAMHS clinicians (n = 24, from 11 Health Trusts) viewed the role of social workers in appropriately assessing mental health problems. Normalisation Process Theory was used to appraise how the SDQ had been routinely operationalised in everyday social work practice. A case study of one local authority explored the working practices of looked after children’s social workers and specialist CAMHS clinicians working in a co-located (high integration) service which had achieved consistently high annual SDQ returns over a number of years. The study found most social workers were not aware of the SDQ scores of the children or young people they were allocated and did not know how to interpret it in terms of looked after children’s mental health. Routinely collected SDQ data on looked after children who had been in care for a year or longer was not utilised by most of the social workers or the local authorities which collected it. Specialist CAMHS used the SDQ alongside social workers in only two local authorities. Level of integration (based on degree of co-location of social workers and CAMHS) did not appear to be associated with social workers’ SDQ use. Detailed examination of one local authority showed that although it contained a highly integrated service and was the best in the country at getting completed SDQ forms returned from foster carers, having a robust process for data collection was not enough to ensure the SDQ was integrated within social work practice in the organisation. Given challenges to local authority budgets and services, any recommendations to improve current practice must be mindful of resource implications. Better utilisation could therefore be made of existing local authority processes and resources to embed the SDQ into routine practice. A multi-agency approach remains critical to establish the routinised usage of the SDQ. This has the potential to benefit all agencies and most importantly, looked after children.